Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Holly Chitwood

Committee Member

Dr. Candice Falls

Committee Member

Dr. Kent Brouwer


BACKGROUND: Healthcare requires quality multidisciplinary communication for patient care. Secure Chat is a feature within the Epic electronic health record to facilitate communication without violating Health Insurance Portability and Accountability Act (HIPPA). An algorithm to streamline communication utilizing this feature is needed to improve patient care.

PURPOSE: The purpose of this study was to determine, develop, implement, and evaluate a communication protocol between nurses and first call providers. The overall goal was to improve the knowledge, attitudes, efficacy, and address barriers with communication of nursing staff and providers through efficient messaging embedded within Epic, electronic health record

CONCEPTUAL MODEL: Plan-Do-Study-Act (PDSA) was utilized as the framework for this study.

METHODS: A quality improvement Secure Chat Algorithm was developed to establish shared goals and outcome measures for communication. An educational session was held and a pre-post survey was conducted to determine the knowledge and attitudes regarding the appropriate use of Secure Chat. Secure chat messages were reviewed 1 month before and after implementation to assess compliance by analyzing specific metrics from Secure Chat communication.

RESULTS: The pre and post survey demonstrated staff compliance with the algorithm but none of the results were significant. The attitudes regarding the appropriate use of the Secure Chat Algorithm did significantly improve pre (mean=3.3, SD=1.0) and post (mean=4.2, SD=0.4), p-value=0.01 CONCLUSION: The results demonstrated that it may be beneficial to review and optimize the flow of the algorithm to improve compliance with the Secure Chat Algorithm. However, the use of a communication algorithm did display improved communication measures.